Barton: Doctor in the house

I don’t know what others in the local medical-industrial complex may think about Dr. Clark Deriso’s diagnosis of what’s ailing health care in this country and his prescription for treatment.

But as someone on the receiving end of the healing arts, I think parts of it sound spot-on.

Deriso is a 70-year-old orthopedic surgeon in Savannah who still practices. He brings a lot of time, experience and perspective to the examining table. He’s also full of opinions and not bashful about sharing them.

On Friday morning, Deriso gave an hour-long presentation to about 30 of his peers with the Norfolk Southern Association of Physicians, based in Norfolk, Va., meeting this weekend in Savannah at the Mulberry Inn.

In a nutshell, here’s what he said are among the problems, none of which is surprising: It’s expensive; there’s too much waste and greed; patients feel like cash registers and not people; physicians feel like cogs and powerless to change things.

Here are some of the fixes that Deriso prescribed, some of which might raise an eyebrow: Eliminate the profit incentive; stop spending money on costly technology that does little except put more dough in people’s pockets; say “no” to expensive surgical procedures and drugs that don’t improve outcomes; implement a single-payer plan; close medical schools.

Close medical schools? Aren’t states like Georgia expanding their schools to meet future needs?

Bad idea, Deriso said. “When you produce more physicians, you also raise the cost of health care because they all have to do something to make money,” he said. “You wind up with too many people doing too many things to too many people.”

Some of those “things” are highly suspect, he said, including his area of expertise — orthopedic surgery. In a Powerpoint image, he showed the visiting docs a map of the United States. It was highlighted to show where people with aching backs, bad knees, faulty shoulders and neck pain were most likely to undergo operations.

The Southeast — including this part of Georgia — was a hot spot for surgery. So was the Northwest. The surgery rates there were five to 15 times greater than other regions, like the Northeast. That area looked like a dead zone.

“That’s because people who live up there don’t have any backbone,” one doc in the audience chuckled.

Not so, Deriso said. Instead, he suggested, it’s a money issue. It’s not a patient care issue. He even argued that “your back is safer in the Northeast than the Southeast” because operations are being aggressively performed that aren’t really necessary, yet have the potential to do harm.

“People want to get in on the action,” he said. “There’s a sea of money out there.”

Deriso suggested that through the 1950s, most people who chose the medical profession did so to help people. Affluence was far down on the priority list. But then came the explosion of third-party payers like government health-care plans and private insurance.

“Because of third-party payers, a lot of people went into medicine and got rich,” Deriso said.

The surgeon said he’d like to see medicine return to its roots.

“Practicing medicine is an art, not a trade. It’s a calling, not a business. It can never be a true business because it doesn’t respond to usual market forces.”

One older physician in the audience suggested Deriso was ignoring today’s realities.

“When you get out of medical school and $300,000 in debt, that makes it a business,” he said.

But a cardiologist in the crowd offered another perspective on reality, following a discussion about the tremendous amount of money spent to keep people alive during the last few months of life.

“I started recommending hospice care to patients,” he said. “I was fired.”